Appropriate Use Criteria for Imaging of Congenital Heart Disease Patients: Key Points

Authors:
Sachdeva R, Valente AM, Armstrong AK, et al.
Citation:
ACC/AHA/ASE/HRS/ISACHD/SCAI/SCCT/SCMR/SOPE 2020 Appropriate Use Criteria for Multimodality Imaging During the Follow-Up Care of Patients With Congenital Heart Disease: A Report of the American College of Cardiology, American Heart Association, American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and Society of Pediatric Echocardiography. J Am Coll Cardiol 2020;Jan 6:[Epub ahead of print].

The following are key points to remember about the multisociety 2020 Appropriate Use Criteria for Multimodality Imaging During the Follow-Up Care of Patients With Congenital Heart Disease:

  1. In applying these criteria, it is important to use them in the setting of an individual patient’s situation. A “Rarely Appropriate” rating does not mean “inappropriate” or “never appropriate.” Similarly, an “Appropriate” rating does not mean the test should or must be used in all clinical situations.
  2. A “May Be Appropriate” rating suggests that imaging studies in this category may be used depending on individual patient circumstances.
  3. This document is unique in that it addresses all commonly used imaging modalities for congenital heart disease, as opposed to focusing on one specific modality.
  4. Imaging studies generally receive "Appropriate" ratings in the setting of a change in clinical status or new or concerning symptoms.
  5. The transthoracic echocardiogram (TTE) was generally rated as "Appropriate" for the routine surveillance for patients with congenital heart disease. Frequency of follow-up imaging is based on the nature and complexity of heart disease and a patient’s clinical status.
  6. Cardiovascular magnetic resonance (CMR) imaging was generally rated as “Appropriate” for periodic surveillance of patients with complex heart disease. CMR can be particularly helpful when the right ventricle is the ventricle of interest, including patients with systemic right ventricle and tetralogy of Fallot, and Ebstein anomaly.
  7. Cardiovascular computed tomography (CCT) was rated most highly for the assessment of coronary or complex vascular anatomy. Specific indications for CT include congenital coronary anomalies and the assessment of coronary arteries in patients after the arterial switch procedure. CCT also has a role in the assessment of patients where CMR imaging may be suboptimal (e.g., metallic artifact) or for patients unable to undergo CMR for various reasons.
  8. Stress imaging was generally rated “Appropriate” and “May Be Appropriate” in the detection of ischemia in patients with coronary anomalies and transposition of the great arteries.

Keywords: Cardiac Imaging Techniques, Diagnostic Imaging, Ebstein Anomaly, Echocardiography, Exercise Test, Fluoroscopy, Heart Defects, Congenital, Magnetic Resonance Imaging, Multidetector Computed Tomography, Multimodal Imaging, Tetralogy of Fallot, Tomography, Tomography, X-Ray Computed, Transposition of Great Vessels


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